Examining the Postoperative Outcomes After Minimally Invasive Versus Open Fixation of Thoracolumbar Fractures in Patients With Ankylosing Spondylitis

Study Design: Systematic Review and Meta-Analysis. Objective: This review aims to evaluate medical complications, patient-reported outcomes, and bony healing, operative time, and blood loss after MIS versus open fixation for TL fractures in patients with AS. Summary of Background Data: Ankylosing spondylitis (AS) causes spinal rigidity and increases the risk of vertebral fractures, especially in the thoracolumbar (TL) region. While pedicle screw fixation via percutaneous or open approaches is commonly used, evidence on the safety and bony healing outcomes specifically in AS patients is limited. This study evaluates medical complications, patient-reported outcomes, and bony healing after minimally invasive (MIS) versus open fixation in AS patients with TL fractures. Methods: This systematic review and meta-analysis evaluated postoperative complications and clinical outcomes in patients with AS undergoing MIS or open fixation of TL fractures by querying PubMed, SCOPUS, CINAHL, and Web of Science, up to August 26, 2024. Results: Nine comparative and 4 noncomparative studies (n=443; 77.16% male; mean age 70.74 ± 9.21 y; mean follow-up 24.27 ± 15.10 mo) were included. Bony healing was achieved in 98% (n=111) and 97.14% (n=35) of MIS and open fixation patients, respectively, which was not significantly different ( P =0.978). However, MIS had a significantly shorter mean operative time (150.97 ± 50.96 vs. 251.43 ± 84.36 min; P <0.001), less blood loss (275.73 ± 100 vs. 856.44 ± 294.91 mL; P =0.016) and shorter hospital stay (17.68 ± 10.93 d vs. 32.44 ± 13.58 d; P <0.001) compared with open fixation, respectively. Revision surgery was necessitated in 1.39% (n=1) of MIS patients and in 8% (n=4) of open fixation patients, which was not found to be significantly different ( P =0.135). Conclusions: Percutaneous MIS instrumented fixation for TL fractures in patients with AS is viable, affording comparable bony healing, reduced blood loss, operative time, and hospital stay compared to traditional open fixation.